Private Practice is not Dead. It is Simply being Re-engineered.

Despite Chicken Little’s warnings that the “sky is falling”, the world did not end and she (more affectionately known as Henny-Penny) and her friends Rooster-Booster, Ducky-Chucky, Goosie-Brucie and Turkey-Perky all lived happily ever after.

We have the power to create our own realities. Unfortunately, our filters sometimes have us believing things that are not true. Such are formed perceptions. Without further ado, let me put a fork to the belief that the end is coming to private practice. It is not! What is changing is how private practice shall survive and shall get stronger.

First, Understand the Forces in your Landscape

  • Western Dental started in Los Angeles in 1903.
  • Dental Service / Support Organizations (DSOs) have been part of the oral healthcare delivery system for over two generations. Heartland Dental hit the beach in 1982.
  • Dental insurance is an expected employee benefit and is available for anyone who wishes to purchase it.
  • Dental insurance is a far different product than medical insurance.
  • Dental insurance benefits have not kept pace with the rising costs of providing oral healthcare services.
  • Delta Dental does not allow providers to play on a level playing field. DSOs are able to contract higher fees than those fees contracted by private practitioners.
  • Dentists have become a commodity.
  • Practices that bounced back from the Covid Shutdown had strong hygiene departments.
  • Owning and operating a practice requires considerable attention and dictates constant capital investments.
  • Being a W-2 / 1099 dentist makes one’s professional life easier to manage.
  • There is considerable pride and immense satisfaction standing behind something that has one’s brand stamped on it!

Study the Game Board

Focus on the end-user of your services. What consumer segment do you wish to serve? How can you attract and retain them? Focus on your product. Do you consider your services retail oriented or highly personalized and customized?  Define who you wish to be. Strategize. Understand the advantages that stack in your favor. Here are two which forecast favorably for the future of private practice.

The number of privately-owned practices shall be fewer and most dentists shall never own a practice. Understand that the number of DSO practices will always be  growing. Determine how you can take advantage of this. Study human psychology and purchasing habits. What sectors do consumers seek purchase discounts, and what sectors do they consider making long-term investments with cost being a secondary consideration?

Understand the power that “trust” forges and the appreciative value consumers place in being made to feel valued.

Realize that there are consumers with high dental IQs who understand the importance of maintaining their oral health and the impact that it has on their overall well-being.

These consumers wish to be properly courted. Knowing this, how do you wish to play this Game?

Prepare yourself for this highly competitive landscape. Invest in yourself through constant CE. Improve your skillset and become more than a generalist. Dentists acquiring practices today have many arrows in their quiver and are properly prepared to walk their clinical hallways. Align yourself with skilled advisors, employ the best coaches and place some cheerleaders on your sideline. This is serious advice. Those who operate high-level successful practices did not get there on their own.

Create a “Best Practice” Mindset

Surround yourself with successful colleagues. Read articles which help format you for operating a successful practice. Join a study group of successful practitioners. Determine that level you wish to operate at and then create the model which shall reward you financially for the investments you shall be making.

Do not allow yourself to be victimized by the insurance industry. You can work 28-clinical hours a week treating 6-to-8 patients a day and make $250,000+ a year if you create the right model. If you seek greater rewards, roll up your sleeves. This is America, the land of opportunity!

Pay close attention to your marketplace. Work on creating a competitive edge. Grow your brand. Upgrade your technology. Employ artificial intelligence. Outsource your Accounts Receivable so the front desk can concentrate on scheduling and interfacing with your patients. Carefully monitor the costs of acquiring supplies. Make sure you are properly coding procedures.

Determine who your rock stars are and promote them!  Create and maintain the right social media content that attracts the audience you seek.  Improve efficiencies and determine where your focus needs to be. Monitor your recall / hygiene department. Work hard on retaining your patients. They are your best source for the new patients you seek. “Watches” shall eventually become scheduled work.

As patients get older, there shall be greater harvests to be realized.  Employ a great front line in your practice as this point of contact sets the tone.  Imagine yourself as an actor on stage. Determine the audience you seek.

If you are a General or Pediatric Dentist, realize the power you have as the oral healthcare gatekeeper. Capitalize on this! You control the procedure paths for your patients. Retain as many services as possible inhouse.

The Premier Providers Network is Being Shut Down

Regarding Delta, there should never have been the provider billing inequities which were created in April 2011 when new network providers were denied Premier-only status. The private club of Premier providers is being shut down. Delta’s endgame has always been to eliminate their Premier product.

It has taken 12+ years and litigation to get to the new announcement Delta shall be making in 2023. This shall be one more step for Delta to level the playing field for private practitioners. It is best to understand that this is the result of the growing costs of employer-paid benefits. Very simply, employers have not been paying the costs for providing the Premier product for their employees.

This in turn has sparked for the quiet revolution that has been playing out. Many practices are now insurance independent. Others are working on their independence. This is the absolute best outcome for the end-user, the consumers.

Perhaps you operate in an area where you truly believe that going out-of-network would have dire consequences. A past client operated an out-of-network practice doing $1 Million/year with his working 20-clinical hours a week. The median household income in his service area was $40,000. I asked: “How are you able to do this?” He looked at me and simply stated: “I am worth it!” He had attitude! His practice had a very busy hygiene schedule and the staff knew they were the best compensated dental team in the area. He was constantly receiving resumes in the event an opening presented itself.


In closing, it is important to outline that insurance-dependent practices can also perform well. But the operating margins are far tighter with a large percentage of their patients conditioned to maintain their oral health within the parameters of their annual benefits. Sharp pencils need to be maintained and the treadmill turns faster. Such practices should employ specialists to retain services in-house. And this operating model is on the same playing field as a corporate model who is able to contract higher Delta fees.

What do you want out of your career? How will you handle your Game Board? Do you have attitude?